Technical Consideration for Coiling of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm

Abstract

ObjectiveSurgical obliteration of ruptured aneurysm of the proximal posterior inferior cerebellar artery (PICA) is challenging because of limited surgical accessibility. In recent years, coil embolization is the first-choice treatment for these lesions. However, coil embolization is not always easy in ruptured PICA aneurysm owing to the variable anatomical diversity of its shapes, its relationship to the parent artery, its low incidence, and accordingly, lesser neurointerventionist experience.MethodsThe parent artery and microcatheter for easier navigation and the embolization technique for stable coiling were identified.ResultsThis study aimed to identify the more appropriate approach route, microcatheter, and strategies for an easier and safer, and more durable coil embolization in the treatment of lesions in the proximal PICA.ConclusionCoil embolization for aneurysmal subarachnoid hemorrhage due to a ruptured proximal PICA remains a challenge, but with the appropriate coiling plan, it can be treated successfully.

Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

“…1,4,5,7 Recently, the utility of retrograde access to the acutely angled PICA has been reported. 3,4,6,7 A limitation of this approach may be the potential risks associated with catheterization into a hypoplastic VA, as in our case. However, Heye et al reported that a hypoplastic V4 segment of the contralateral VA was not a contraindication for this approach.…”

“…In addition, tight angulation of the PICA from the vertebral artery (VA) may make access to the PICA difficult from the ipsilateral VA if adjunctive techniques are needed. 1,[3][4][5][6][7] The small caliber and tight angulation of the PICA may cause kinking of the stent and create flow disturbance when treated via ipsilateral access using stent-assisted technique. 7 Recently, the safety and efficacy of retrograde access to an angled PICA from the contralateral VA or posterior communicating artery have been reported.…”

“…7 Recently, the safety and efficacy of retrograde access to an angled PICA from the contralateral VA or posterior communicating artery have been reported. 3,4,6,7 Herein, we report a case of endovascular treatment for an unruptured VA-PICA aneurysm using a stent-assisted technique with retrograde access via contralateral type 1 persistent primitive proatlantal artery (PPA) because the contralateral VA origin was not confirmed. This treatment strategy has not been reported previously and may illuminate the possibility of PPA as an approach route.…”